1983221 tn?1333506185

Steroids for ON?


My neurologist wants me to take steroids as my ON isn't resolving and is getting painful.  My worry is that I thought that taking steroids could cause the ON to come back worse the next time.... has anyone heard of this?
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1475492 tn?1332884167
Oh, I misread --- not worsening of symptoms but I've read articles where ON treated with oral steroids has been linked to recurrent ON.

Treatment of optic neuritis has changed in recent years, due to a landmark series of studies known as the Optic Neuritis Treatment Trials (ONTT).

In these studies, people with optic neuritis were randomized for treatment with intravenous (IV) steroids, oral steroids or placebo. Afterward they were evaluated for several years.

Left: A healthy optic nerve is essential for good eyesight. Right: Optic neuritis damages the optic nerve.

From these studies, researchers learned that treatment with steroids had little effect on the final visual outcome in patients with optic neuritis.

However, patients treated with IV steroids had fewer repeat attacks of optic neuritis than patients treated with oral steroids alone. In fact, those treated with oral steroids alone had a higher risk of repeat attacks of optic neuritis than those treated with placebo.

Even more importantly, patients treated initially with IV steroids had about half the risk of developing MS in two years as patients treated with oral steroids only, or placebo. Of those treated with IV (followed by oral) steroids, 7.5 percent developed MS in the following two years, versus about 16 percent in the other groups.

As a result of the ONTT, eye doctors now treat patients with a combination of IV and oral steroids or monitor the condition without prescribing medical treatment. Use of oral steroids alone is not recommended.
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1983221 tn?1333506185
Thanks Doublevision!
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382218 tn?1341181487
I've never heard this or come across research that suggests treating ON with corticosteroids will cause more severe ON in future.

There was a study in the 90s that demonstrated that undx'ed patients suffering with ON for the first time who were treated with corticosteroids were more likely to stave off developing MS for at least two years.  Results were better with IV than with oral. Results with oral were slightly better than placebo.  It's believed high dose corticosteroids have a neuroprotective effect.

However as you're already dx'ed and that horse has already left the barn, this info is probably not all that useful to you.  

The only cautions I've been given with regards to corticosteroids is that they may lose efficacy over time with repeated use, and specific side effects/risks whcih increase with repeated use such as osteoporosis.

I had a 5 day course of IVSM when I had ON a few years ago.  First dose was given less than 24 hours after onset, as it came on quickly and was very painful.  Vision retured to normal within a few days, pain subsided after first dose.  I was also given morphine and Toradol at the ER prior to them starting the IVSM as I was in agony.

My neuro-ophtha said that although the research only proves that IVSM will improve speed and not degree of recovery from ON, he thinks it's very possible my vision returned to normal with no residual damage because of how quickly the IVSM was administered after onset.  He said he often sees this in his practice.

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1983221 tn?1333506185
Hmmm... it's was oral steroids that she prescribed.  I wonder if I should just try to power through this painful period.  I don't want the ON to get worse!
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1475492 tn?1332884167
Oral...yes. IVSM ... no.

I loved the steroids. I would consider it heavily if your symptoms haven't resolved.

I tolerated it well and it did resolve the symptoms right away. You just need to prepare yourself to taking it easy for about a a week after ending them.

I hope you feel better.
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